Development, validation, and results of a national endoscopy safety attitudes questionnaire (Endo-SAQ)

Abstract

Background and study aims Safety attitudes are linked to patient outcomes. The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) identifies the need to improve our understanding of safety culture in endoscopy. We describe the development and validation of the Endo-SAQ (endoscopy safety attitudes questionnaire) and the results of a national survey of staff attitudes.

Methods Questions from the original SAQ were adapted to reflect endoscopy-specific content. This was refined by an expert group, followed by a pilot study to assess acceptability. The refined Endo-SAQ (comprising 35 questions across six domains) was disseminated to endoscopy staff across the UK and Ireland. Outcomes were domain scores and the percentage of positive responses (score ≥75/100) per domain. Descriptive and comparative analyses were performed. Binary logistic regression identified staff and service factors associated with positive scores. Validity and reliability of Endo-SAQ were assessed through psychometric analysis.

Results After expert review, four questions in the preliminary Endo-SAQ were adjusted. Sixty-one participants undertook the pilot study with good acceptability. A total of 453 participants completed the refined Endo-SAQ. There were positive responses in teamwork, safety climate, job satisfaction, and working conditions domains. Endoscopists had significantly more positive responses to stress recognition and working conditions than nursing staff. JAG accreditation was associated with positive scores in safety climate and job satisfaction domains. Endo-SAQ met thresholds of construct validity and reliability.

Conclusions Endoscopy staff had largely positive safety attitudes scores but there were significant differences across domains and staff. There is evidence for the validity and reliability of Endo-SAQ. Endo-SAQ could complement current measures of patient safety in endoscopy and be used in evaluation and research.

Keywords

Quality and logistical aspects - Quality and logistical aspects - Performance and complications - Quality and logistical aspects - Training

• References

• 1 NHS Improvement. A just culture guide. https://improvement.nhs.uk/documents/2490/NHS_0690_IC_A5_web_version.pdf
• 2 Braithwaite J, Herkes J, Ludlow K. et al. Association between organisational and workplace cultures, and patient outcomes: systematic review. BMJ Open 2017; 7: e017708
• 3 The Health Foundation. Does improving safety culture affect patient outcomes?. https://www.health.org.uk/sites/default/files/DoesImprovingSafetyCultureAffectPatientOutcomes.pdf
• 4 Berry JC, Davis JT, Bartman T. et al. improved safety culture and teamwork climate are associated with decreases in patient harm and hospital mortality across a hospital system. J Patient Safety 2020; 16: 130-136
• 5 keswani rn, malpas pm, lynch s. et al. 557 errors in the endoscopy lab correlate with lower safety attitudes: an assessment of safety culture among U.S. nurses. Gastrointest Endosc 2015; 81: AB153
• 6 NHS Improvement. The NHS Patient Safety Strategy. https://improvement.nhs.uk/resources/patient-safety-strategy/
• 7 Sexton JB, Helmreich RL, Neilands TB. et al. The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res 2006; 6: 44
• 8 Famolaro T, Yount N, Burns W. et al. Hospital survey on patient safety culture: 2016 user comparative database report. In: Agency for Healthcare Research and Quality (AHRQ). 2016
• 9 University of Manchester. Manchester Patient Safety Framework (MaPSaF). http://www.ajustnhs.com/wp-content/uploads/2012/10/Manchester-Patient-Safety-Framework.pdf
• 10 Kho ME, Carbone JM, Lucas J. et al. Safety climate survey: reliability of results from a multicenter ICU survey. Qual Safety Health Care 2005; 14: 273-278
• 11 The Health Foundation. Research scan: measuring safety culture. https://www.health.org.uk/sites/default/files/MeasuringSafetyCulture.pdf
• 12 Gabrani A, Hoxha A, Simaku A. et al. Application of the Safety Attitudes Questionnaire (SAQ) in Albanian hospitals: a cross-sectional study. BMJ Open 2015; 5: e006528
• 13 Zimmermann N, Küng K, Sereika SM. et al. Assessing the safety attitudes questionnaire (SAQ), German language version in Swiss university hospitals - a validation study. BMC Health Services Research 2013; 13: 347
• 14 Zhao C, Chang Q, Zhang X. et al. Evaluation of safety attitudes of hospitals and the effects of demographic factors on safety attitudes: a psychometric validation of the safety attitudes and safety climate questionnaire. BMC Health Services Research 2019; 19: 836
• 15 Göras C, Unbeck M, Nilsson U. et al. Interprofessional team assessments of the patient safety climate in Swedish operating rooms: a cross-sectional survey. BMJ Open 2017; 7: e015607
• 16 Profit J, Etchegaray J, Petersen LA. et al. The Safety Attitudes Questionnaire as a tool for benchmarking safety culture in the NICU. Arch Dis Child Fetal Neonatal Ed 2012; 97: F127-F132
• 17 Joint Advisory Group on Gastrointestinal Endoscopy. Improving Safety and Reducing Error in Endoscopy (ISREE) implementation strategy. https://www.thejag.org.uk/Downloads/JAG/General/Improving%20Safety%20and%20Reducing%20Error%20in%20Endoscopy%20(ISREE)%20Implementation%20strategy%20v1.0.pdf
• 18 Joint Advisory Group on Gastrointestinal Endoscopy. Joint Advisory Group on Gastrointestinal Endoscopy (JAG) accreditation standards for endoscopy services. https://www.thejag.org.uk/downloads/Accreditation/JAG%20accreditation%20standards%20for%20endoscopy%20services.pdf
• 19 Cook DA, Brydges R, Ginsburg S. et al. A contemporary approach to validity arguments: a practical guide to Kane's framework. Med Educ 2015; 49: 560-57
• 20 Polit DF, Beck CT. The content validity index: are you sure you know what's being reported? Critique and recommendations. Res Nurs Health 2006; 29: 489-497
• 21 Ravindran S, Bassett P, Shaw T. et al. National census of UK endoscopy services in 2019. Frontline Gastroenterol 2020;
• 22 Cohen L, Manion L, Morrison K. Research Methods in Education. 8, Ed. New York: Routledge; 2017
• 23 Jackson DL, Gillaspy Jr, Purc-Stephenson R. Reporting practices in confirmatory factor analysis: An overview and some recommendations. Psychological Methods 2009; 14: 6-23
• 24 dos Santos PM, Cirillo MÂ. Construction of the average variance extracted index for construct validation in structural equation models with adaptive regressions. Communications in Statistics - Simulation and Computation 2021;
• 25 Browne MW, Cudeck R. Alternative ways of assessing model fit. Sociol Methods Res 1992; 21: 230-258
• 26 Hu Lt, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equation Model 1999; 6: 1-55
• 27 Hair JF, Black WC, Babin BJ. et al. Multivariate data analysis. 8th edition. Hampshire, UK: Cengage Learning; 2019
• 28 Terwee CB, Bot SDM, de Boer MR. et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 2007; 60: 34-42
• 29 Ravindran S, Bassett P, Shaw T. et al. Improving safety and reducing error in endoscopy (ISREE): a survey of UK services. Frontline Gastroenterol 2020;
• 30 Koontalay A, Suksatan W, Prabsangob K. et al. Healthcare workers' burdens during the COVID-19 pandemic: a qualitative systematic review. J Multidiscip Healthcare 2021; 14: 3015-3025
• 31 Carney BT, Mills PD, Bagian JP. et al. Sex differences in operating room care giver perceptions of patient safety: a pilot study from the Veterans Health Administration Medical Team Training Program. BMJ Quality Safety 2010; 19: 128
• 32 Rabinowitz LG, Grinspan LT, Kim MK. Gender in the endoscopy suite. Lancet Gastroenterol Hepatol 2020; 5: 1032-1034
• 33 Matharoo MK, Sethi A, Charabaty A. Towards meaningful change: the future of gastroenterology belongs to women, diversity, equity, and inclusion. Lancet Gastroenterol Hepatol 2021; 6: 518-520
• 34 Ching H-L, Lau MS, Azmy IA. et al. Performance measures for the SACRED team-centered approach to advanced gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2022; 54: 712-722